Backup Documents 10/28/2014 Item #16E2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO IRE6 E2THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATL�
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office 10/219-
4. BCC Office Board of County
Commissioners A.5/
5. Minutes and Records Clerk of Court's Office .7(Y\ `0( �y 3;�,34t
l I Qm
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Kathy Heinrichsberg f Xe ci t.44 4 e Phone Number 252-3622
Contact/ Department Seco-e.4-e*✓�
Agenda Date Item was October 28,2014 6 uie4 K o f Agenda Item Number
Approved by the BCC e.r o,, 16E2
Type of Document Number of Original 2
Attached Permit and Certificate S�r`�`c.e s Documents Attached (1.— re v
PO number or account I C2 Pc I V
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) pplicable)
1. Does the document require the chairman's original signature? KH
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A V
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be KH
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the KH
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's KH ✓
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KH
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 10/28/2014(enter date)and all changes KH N/A is not
made during the meeting have been incorporated in the attached document. The an option for
County Attorney's Office has reviewed the changes,if applicable. `lis line.
9. Initials of attorney verifying that the attached document is the version approved by the KH 1A is not
BCC,all changes directed by the BCC have been made,and the document is ready for t p ' a option for
Chairman's signature. t is line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1 6E 2
MEMORANDUM
Date: October 31, 2014
To: Kathy Heinrichsberg, Executive Secretary
Bureau of Emergency Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: North Naples Fire Control and Rescue District Permit
and Certificate of Public Convenience and Necessity for
Class 3 Advanced Life Support Non-transport Services
Attached is a certified copy of the permit and a copy of COPCN referenced above,
(Item #16E2) approved by the Board of County Commissioners October 28, 2014.
The originals will be held in the Minutes and Records Department for the Board's
Official Record.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachments
16E2
COLLIER COUNTY FLORIDA
Renewal of Class "3" COCPN
This Permit is effective January 1, 2015 and
Expires December 31, 2015
Name of Service: North Naples Fire Control and Rescue District
Name of Owner: North Naples Fire Control and Rescue District
Principle Address of Service: 1885 Veterans Park Drive,Naples, FL 34109
Business Telephone: 239-597-3222
Description of Service: Non-Transport Advanced Life Support
Number of Ambulances: 18 Ground Units available.
See Application for Description of Vehicles
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Non-transport ALS Service to operate within the North Naples Fire Control
response boundary and pursuant to the Collier County Fire Chiefs Local Mutual Aid
Agreement until the expiration date hereon, except that this permit may be revoked by the
Board of County Commissioners of Collier County at any time the service named herein
shall fail to comply with any local, state or federal laws or regulation applicable to North
Naples Fire Control and Rescue District.
Issued and approved this a S.+ day of er-G-eJ-. , 2014
ATTEST: - ,,, BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BRt5eK, CLERK COLLIER CO TY, FLORIDA
,# , g+e IC
Attest a1' j Clerk Tom Henning, Chi an
signature only
Approved as to form and legality:
Jennifer A. Bel \I
ko
Assistant County Attorney z J p\\
[14-EMG-00333/1123457/1]
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